Expected changes in physician outpatient interventional practices as a result of coronavirus disease 2019 and recent changes in Medicare physician fee schedule.

OBJECTIVE: We examined the economic and practice effects of the coronavirus disease 2019 (COVID-19) pandemic and decreased Medicare physician payments on outpatient vascular interventional procedures. METHODS: A 21-point survey was constructed and sent electronically to the physician members of the Outpatient Endovascular and Interventional Society and the American Vein and Lymphatic Society. The survey responses were converted to a Likert scale and statistical analyses performed to examine the associations between the response variables and the characteristics and practice patterns of the physician respondents. RESULTS: A total of 165 physicians responded to the survey, of whom 33% were vascular surgeons, 18% were radiologists, and 15% were general surgeons. For slightly more than one half (55%), their interventional practice was limited to the office setting, with the remainder also performing procedures in an office-based laboratory (OBL), ambulatory surgery center (ASC), or hospital. Almost all respondents had performed superficial venous interventions, with slightly more than one third also performing either deep venous procedures and/or peripheral arterial interventions. The COVID-19 pandemic had affected 98% of the practices, with a staff shortage reported by 63%. The most-established physicians, those with the longest interval since training completion, were the least likely to have experienced staff shortages. Almost all (94%) the respondents expected that the recent Medicare payment changes will have a negative effect on their practice. Physicians with only an office-based practice were less likely to add a physician associate compared with those with an OBL (P = .036). More than one quarter reported that it was likely they would close or sell their interventional practice in the next 2 years and 43% reported they were planning to retire early. The anticipated ameliorative responses to the decreased Medicare physician payments included adding wound care (24%) or other clinical services (36%) to their practices, with the alternatives considered more by younger physicians (P = .002) and nonsurgeons (P = .047). Only 10% expected to convert their practices to an ASC or hybrid ASC/OBL (16%). CONCLUSIONS: The emotional and economic effects of the COVID-19 pandemic and the decreased Medicare physician reimbursement rates for vascular outpatient interventionalists have been significant. Even greater challenges for the financial viability of office practices and OBLs can be expected in the near future if additional further planned cuts are put into effect.

Expected Changes in Physician Outpatient Interventional Practices as a Result of COVID-19 and Recent Changes in Medicare Physician Fee Schedule

Objective To examine the economic and practice effects of COVID-19 and decreased Medicare physician payments on outpatient vascular interventional procedures. Methods A 21 point survey was constructed and sent electronically to the physician members of the Outpatient Endovascular and Interventional Society and the American Vein and Lymphatic Society. Survey responses were converted to a Likert scale and statistical analyses performed to examine the association between the response variables and the characteristics and practice patterns of the physician respondents. Results A total of 165 physicians responded to the survey of which 33% were vascular surgeons, 18% were radiologists and 15% general surgeons. Slightly more than half (55%) had their interventional practice limited to the office setting while the others also performed procedures in an OBL, ASC or the hospital. Almost all performed superficial venous interventions with slightly more than one-third also doing either deep venous procedures and/or peripheral arterial interventions. The COVID-19 pandemic impacted 98% of practices with staff shortage reported by 63%. The most established physicians, those with more years since completion of training, were least likely to have experienced staff shortages. Almost all, 94%, expect that the recent Medicare payment changes will have a negative effect on their practice. Physicians with only an office-based practice are less likely to add a physician associate as compared to those with an OBL (P=0.036). More than one quarter think it likely they will close or sell their interventional practices in the next two years while 43% plan to retire early. Anticipated ameliorative responses to the decreased Medicare physician payments include adding wound care (24%) or other clinical services (36%) to their practices, alternatives being considered more by younger physicians (P=0.002) and non-surgeons (P = 0.047). Only 10% expect to convert their practices to an ASC or hybrid ASC/OBL (16%). Conclusions The emotional and economic effects of the COVID-19 pandemic and decreased Medicare physician reimbursement rates for vascular outpatient interventionalists have been significant. Even greater challenges for the financial viability of office practices and OBLs can be expected in the near future if additional further planned cuts are put into effect.

The academic experience in distance (virtual) rounding and education of emergency surgery during COVID-19 pandemic.

BACKGROUND: To cope with COVID-19 pandemic control precautions, many surgical residency programs have adopted a Declared Health Emergency rotation to minimize exposure to the COVID-19. We evaluated the experience and educational value of virtual education activities by reviewing the perceptions of the Declared Health Emergency rotation participants through survey questionnaire analysis. METHODS: Participants of the Declared Health Emergency rotation virtual educational activities were asked to complete a survey questionnaire describing their perception and experience. RESULTS: The survey response rate was 100% (faculty, n = 13; residents, n = 8; nurse practitioners/physician assistants, n = 4). The majority reported that virtual activities required minimal technical skills (n = 17, 68%). Compared to the traditional in-person conferences before the pandemic, the majority reported that they participated in virtual rounds more often or the same (n = 22, 88%), that the overall level and quality of interactions were the same or better (n = 19, 76%), and that the knowledge gained was the same or more (n = 22, 88%). All respondents reported that virtual conferences educational objectives were met. CONCLUSION: The quality of education and the knowledge gain during the virtual educational activities are equivalent or better than in the traditional face-to-face activities. The use of technology in virtual educational activities is a practical and convenient approach to achieve the desired educational objectives during and potentially after the COVID-19 pandemic.

Alternatives surgical training approaches during COVID-19 pandemic.

IMPORTANCE: Coping with the COIVD-19 global-pandemic major changes in healthcare and educational operational policies, mandates the implementation of alternative surgical curriculum objects (components) to replace some of the traditional face-to-face activities. OBJECTIVE: The objective of the study is to review and discuss various alternative curriculum objects (components) that can be used to restructure conventional surgical training curricula during the Declared Healthcare Emergency surgery rotations. The goal is to identify and recommend effective alternative educational activities that are compliant with the new social physical distancing regulations. EVIDENCE REVIEW: Various curricular components and objects were examined. The educational value of the curriculum objects is studied and analyzed in terms of feasibility, knowledge gain/learning effectiveness, the need for facilitation or feedback, and the evaluation. Several curriculum objects were proposed with description of their value and applications. FINDINGS: The selected and proposed activities include scenario-based MCQ writing exercises, video-based surgical skills interactive training, online learning modules, virtual rounding, reflection assignments, surgical skills simulation training, research education, and medical education learning. Their educational value is described and scaled. CONCLUSION: There is urgent and challenging need for surgical training using additional alternative curriculum objects (components). Working with the available resources and experiences is crucial to maximize the learning outcomes. Distance (online) education and educational technology tools and concepts provide a spectrum of valuable educational activities. Further work and studies are needed to optimize their utility.